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Healthwatch Shropshire

An analysis of the awareness and attitudes towards the complaints procedures in local general practices in

Shrewsbury, from the perception of patients and staff members.

Aisling McCann

Eve Horner

Marianne Pourikkou-James

Word Count : 1947

March 2018

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Contents

Introduction

Project Aims

Method

Results

Evaluation

Recommendations

Handover and future development

Acknowledgments

References

Appendix 1 Questionnaire for GP Staff

Appendix 2 Questionnaire for Patients

Appendix 3 Focus group questions

Appendix 4 Handover Form

Appendix 5 Record of engagement

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Introduction:

Healthwatch Shropshire is a local organisation and registered charity that is based in

Shrewsbury. The organisation is part of a network of Local Healthwatches across England that were established by the Health & Social Care Act 2012.

Healthwatch Shropshire helps to ensure everyone gets the best from their health and

social care services, also that those services are as good as they can be and work in

a connected way. They do this by giving the general public the opportunity to voice

their opinion on the health and social care services which affect them and gathering

the experiences of local people to influence commissioning, provision and scrutiny of local health and social care services (2).

Their mission is ‘to be the recognised independent voice of the people of Shropshire

in seeking to improve their experience of Health and Social Care services.’ [1]

Funding for local Healthwatches comes from Department of Health via local councils,

Healthwatch Shropshire is commissioned by Shropshire council. The organisation

prides itself in being the ‘health and social care champion for people and local communities in Shropshire.’ [1]

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Project Aims:

To explore people’s experiences of providing feedback on and making a complaint

about health and social care services:

• Learn about the local GP complaint processes

• Engage with people to gather experiences

• Identify barriers to people sharing their experiences/making a complaint

• Identify staff knowledge of complaints procedure at practice

• Identify good practice

• Develop recommendations that can be taken forward locally

We first met with Adelle Wilkinson (Community Engagement Officer) to discuss the

potential project themes in December and we unanimously agreed on the topic of

complaints within the NHS. This title seemed to spark the most conversation and

interest within the group. Adelle kindly arranged for us to meet with Lynn Cawley, a

member of the Healthwatch Shropshire team, who is the coordinator for the ‘Independent Health Complaints Advocacy Service’(IHCAS).

In this meeting we learnt a lot about the legalities of making a complaint and the

procedures that need to be followed for a formal complaint. We discussed the

differences between formal and informal complaints and the role of patient advice

and liaison services (PALS) within the hospital. We specifically learnt about the

IHCAS service delivered by Healthwatch Shropshire for patient complaints. They

provide an advocacy service for the general public, but cannot complain for people, their role lies within empowering people to make complaints.

After this meeting, we realised the complexities of the complaints policies and

procedures and the differences within primary and secondary care. We decided to

focus our project on the complaints solely within primary care, specifically in the

practices that we were individually attached for general practice, Claremont Bank

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Surgery, Beeches Medical Practices and Riverside Medical Practice. We agreed that

the tasks of exploring complaints within primary and secondary care would not have been achievable in the allocated time.

Method:

We used a structured questionnaire for patient and staff responses to gain insight

into knowledge about complaints in a general practice setting. We used a

combination of quantitative and qualitative questions, specifically aimed to use

dichotomous questions for accessibility for all our respondents. We focused on

questions including awareness and knowledge of complaints procedure within staff

and patients, and factors we felt that may influence their knowledge. We included

some open qualitative questions to clarify knowledge of both patients and staff

members.

The questionnaires were drafted and trialled on respondents, so we could refine in

on flaws within our wording or style of the questions. This led to some improvements

within the questions and later were approved by Keele University for use. [Appendix

1 & 2]

We decided on allocating ten of each patient and staff questionnaires in each of our

three GP practices, this gave us a total of thirty respondents for each patient and

staff questionnaires, and an idea of a general trend emerging.

We randomly allocated the patient questionnaires to the patients of all clinicians, not

specifically our own patients attending the surgery to reduce selection bias, and with

staff questionnaires we aimed to get an even spread of clinical and non-clinical staff

members.

Once the questionnaires were completed and handed back to reception staff, we

analysed the responses and were able to compile these results into graph form.

Based on the patient questionnaire feedback we compiled some questions to focus

on areas for improvement and further engagement from a patient perspective at the

Shropshire Patient Group (SPG) [Appendix 3]. Collectively we decided to use the

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SPG as our patient population focus group due to time constraints and difficulty

arranging appropriate meeting with each of our practices own PPGs. We collected

this information at the focus group and looked at common themes emerging and

used this information to confirm our initial conclusions and direct improvements that

may be put in place.

Results:

Results from the patient questionnaires [Appendix 2]:

Through the patient questionnaires, the following data has been collected by thirty randomly selected patients, ten from each of the three GP practices.

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Just over half of the respondents felt that they knew how to make a complaint at their

practice, however fewer patients felt that they were provided with enough information

on the complaints process. 53% of patients would ask staff for information should

they wish to make a complaint. We were surprised to find that 63% of patients felt

comfortable in asking staff for information to make a complaint, and again over two

thirds felt that their care would not be affected if they were to make a complaint. In

contrast to the complaints process, the 60% of respondents did not know how to

provide positive feedback to their practice.

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Results from GP staff questionnaires [Appendix 1]:

We randomly selected ten patients from each of the three GP practices to complete these questionnaires.

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All respondents from the staff questionnaires interacted with patients, with just over

half of them in an administrative job role at their practice. All but one staff member

was aware of the complaints procedure at their practice, however five staff members were not aware of the complaints policy.

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Majority of staff members said that they would advise patients to approach the practice manager, submit a written complaint, or fill in a complaint form should they wish to make a complaint at their practice. Most of the staff members stated that they were aware of where to find the complaints procedure at their practice, mainly through the intranet or discussion with their practice manager. Just over half of staff members questioned were unsure about information available in the waiting area, this is likely due to the mixture of administrative and clinical staff.

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In addition, most felt that they would feel comfortable signposting patients to make a

complaint and would know what to do if a formal complaint was handed to them.

However, six of the respondents highlighted that they felt they have not received adequate training in the complaints process.

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Findings from the SPG Meeting: [Appendix 3]

When asked about barriers that would prevent patients from making complaints,

many agreed there was a ‘hierarchy’ within a medical practice, with doctors at the

top and patients at the bottom. Because of this, they felt that the GPs had most of

power and therefore if they were to make a complaint, the members of the SPG felt

that their care would be affected. They also identified that a paternalistic relationship

existed between older patients and GPs which again prevented these patients from

making complaints as they would not want to upset the balance of their relationship

or be labelled as a trouble maker.

We then asked if they felt that their care would be affected if they were to make a

complaint. The majority of the SPG agreed that their care was likely to be affected,

and therefore this would prevent them from making a complaint. During this

discussion, the words ‘intimidation’ and ‘hierarchy’ were repeatedly used as with the

previous question. In addition, one member of the SPG highlighted the fact that

disadvantaged patients were allocated an advocate (for example, from Healthwatch),

however patients who did not fit within this category were not offered such services.

They explained that they felt an advocate for all patients would be supportive and

remove this barrier to complaining.

We also felt it was important to ask the SPG what they thought could be done to

improve the complaints procedure, or at least make it easier for patients to complain.

Many agreed that anonymising complaints would be difficult, or not appropriate, as

some complaints would need to be escalated and the nature of other complaints

would make patients identifiable. Nonetheless, they did have some suggestions

regarding how to avoid some of the barriers previously identified. For example, the

use of an advocate to direct complaints to, someone who did not work at that GP

practice. They also felt that more information needs to be given to patients regarding

complaining, and that posters or leaflets informing patients on the complaints

process should be friendlier and encourage the use of constructive criticism to

improve services and education of staff.

Regarding positive feedback, the SPG felt that patients were quick to complain but

not so to make compliments. They felt that positive feedback was just as important

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as complaints. Many of the GP practices within the SPG has suggestion boxes for

positive feedback and for constructive criticism, which they felt worked well.

However, they all agreed that such boxes are not appropriate for complaints,

especially for the type of complaints that may need to be escalated.

Evaluation:

Analysis of the patient questionnaires displayed a surprising number of patients who

felt comfortable making complaints about their GP practice, and that the majority of

those asked did not feel their care would be affected by making a complaint.

Discussion with the SPG demonstrated a contrast to this. We felt the results of the

questionnaires may have hindered a true reflection of how these patients felt,

because of the setting, and because the questionnaires were being handed back to

reception staff.

In addition, the suggestion of an independent person to oversee internal complaints

has a potential role in the GP complaints process. Aimed at reducing bias or stigma

attached to making a complaint, and hopefully overcome this hierarchical barrier. We

acknowledge that some complaints are very case specific and therefore are easily

identifiable thus, regardless of the independent complaints advocate, the complaint

would be alerted to the staff member involved and therefore patients may still feel

that their care would be affected and ultimately have no impact on the likelihood of

that patient complaining.

Many staff members understood how to make a complaint and knew how to inform

patients on complaining. We identified that the mainstay of training was an online e-

learning module and one respondent highlighted that they felt this was ‘monotonous’

in free text alongside the question. Therefore, we considered whether role play

scenarios within the practice training day would be beneficial and educational.

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Recommendations:

If we were to repeat this project and improve our methodology, it may be beneficial

to have questionnaires completed by members of the public, independent to the GP

practice and include a larger sample size. Additionally, we could prioritise anonymity

(use of survey monkey) to better our results. This way, respondents may be more

likely to be honest regarding their thoughts about complaining and barriers such as

impact on their care if a complaint were made.

We could also include information given to patients in relation to making complaints

and compliments about the practice and consider improvements to information

available within the patient waiting area.

Education around patient and staff knowledge that not all complaints need to be

formal, possible use of open and informal feedback is valuable to offer constructive

improvements to the practice or service provided.

Handover and Future development

[Appendix 4]

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Acknowledgements

We would like to thank Adelle Wilkinson and Jane Randall-Smith for all their help

and support throughout the project, and a special thanks to the Shropshire Participation Group for allowing us to attend their group.

References

1. Healthwatch Shropshire website: http://www.healthwatchshropshire.co.uk/content/about-us

2. Healthwatch Shropshire Leaflet: http://www.healthwatchshropshire.co.uk/sites/default/files/hws19126.pdf

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Appendix 1: Patient Questionnaire

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Appendix 2: Staff Questionnaire

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Appendix 3 Focus Group Questions “Makingacomplaint:RecommendationswithintheGPsettingfromapatient’sperspective”

Anybarriersthatpreventpatientsfrommakingcomplaints?

Somepatientsfeelthattheircarewouldbeaffectediftheyweretomakeacomplaint–wouldyouagreewiththis?Howcouldthisbeavoided?

Whatdoyouthinkcanbedonetoimprovethecomplaintsprocedure/makeiteasierforpatients?

Positivefeedback/constructivecriticism–doyouthinkthisisasimportantashelpingpatientstomakecomplaints?

Anyadditionalcommentsregardingcomplaints/positivefeedback?

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Appendix 4: Handover Form

Appendix 5: Activity Log

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Project: Healthwatch Shropshire: An analysis of the awareness and attitudes

towards the complaints procedures in local general practices in Shrewsbury, from the perception of patients and staff members.

Wk No Day/Date/Time Proposed plan Actual plan

1 Wed 13th Dec

2017 10am

First meeting with Healthwatch Shropshire

Agreed consensus to focus on the complaints

2 Tues 2nd Jan

2018 10am

Meeting with the Lynn the NHS advocacy complaints

coordinator

Decision to focus on complaints in primary care

3 Tues 9th Jan

2018 9:30am

Drafts of questionnaires Drafts of questionnaires for patients and staff

4 Tues 16th Jan 2018

Final versions of questionnaires created

Final changes to questions and questionnaires made.

Questionnaires sent to Keele for approval

5 Tues 23rd Jan 2018

Trials of questionnaires handed to people

Trials of questionnaires handed to people

6 Tues 30th Jan 2018

Focus group preparation

Questions for focus group discussed

Questionnaires started to be handed out to GP staff and

patients

7 Wed 7th Feb 2018

Focus Group with Shropshire Participation Group (SPG) Focus group

9 Tues 13th Feb 2018 Data collection Data collection

10 Wed 21st Feb 2018

Recording of data in excel document for each practice

Recording of data Report plan

11 Tues 6th March 2018

Discuss Results Plan Report

To do individual parts of report and meet to discuss and put

together

12 Tues 13th March 2018

Meet to discuss report and email to Adelle

To finalise report and start presentation

13 Tues 20th March 2018

Meet to discuss report before sending off final report Met in library to finalise report

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14 Tues 27th March 2018

Practice presentation at Healthwatch, finalise minor

details

14 Thurs 29th March 2018 Presentation Day!